Health Care Without Harm?

A relatively new campaign has come to bear on perceived environmental and health dangers associated with long-term health care practices. Health Care Without Harm (HCWH) was begun in 1996 by a handful of environmental groups, including the Center for Health, Environment, and Justice (now the HCWH headquarters), Commonweal (a California environmental group), Greenpeace, and others. Today, this fast-growing collaborative effort is embodied in a coalition of nearly 350 organizations and boasts a variety of environmental, labor, and health care groups as members. Religious organizations have assumed a prominent role in HCWH activities, as well.

HCWH has three basic goals: mercury elimination, the elimination of the widely used plastic, polyvinyl chloride (PVC), and the elimination of medical waste incinerators. Broadly speaking, these goals are supported because mercury and PVC, as well as dioxins released from the incineration of PVC and other waste materials, are considered to be hazardous to the environment, as well as to patients themselves.

Over time, HCWH has managed to convince hospitals and health care systems of the legitimacy and urgency of their cause. Those who disagree tend to be labeled as greedy profit seekers or defenders of the status quo.

A basic principle that should underlie all morally informed contributions to public debate about complex questions is honesty about the facts. This is perhaps especially true of religious groups, given that they claim to speak with a morally authoritative voice. Close study of various claims made by HCWH, however, raises questions about the extent to which it meets this criteria.

Health Care Without Harm's PVC campaign, in particular, should cause concern. HCWH has maintained that DEHP, an essential chemical additive to PVC, is responsible for a number of health risks. Cancer, kidney damage, decreased fertility, and infant reproductive damage have all, at least at one point, been alleged. This is based on experiments in which mice and rats were fed large quantities of DEHP.

But studies have not reached a consensus to show that these rodents were exposed to levels of DEHP that would correlate with probable levels of human intake. Most importantly, no evidence has found DEHP to cause adverse effects to humans in real world use. Even the studies that come closest to the HCWH claims do not prove anything. For example, HCWH had great things to say about the January 2002 report by the Health Canada Advisory Panel on DEHP in Medical Devices. Health Canada generally concludes that PVC should be phased out for most purposes. Though many other studies have come to quite different conclusions, it is worth noting that Health Canada based their recommendations on speculation, not positive evidence. Ironically, the report begins by noting, “There are essentially no data to confirm toxicity of DEHP or its metabolites in humans; indeed, DEHP has been used in the plastic used to produce blood bags for several decades without reports of disease or unexplained 'abnormalities' in humans. Such limited studies as exist are clearly inadequate in design and outcome to demonstrate cause-effect relationships between DEHP exposure and toxicity.” Yet despite these caveats, the director of Health Care Without Harm responded to this report by saying, “The Health Canada expert panel report is the strongest call to action yet on PVC medical devices softened with DEHP.”

On the other hand, the benefits of PVC plastic have been proven over time. PVC is used in everything from surgical gloves to catheters, tubing, blood bags, and construction material. PVC is a very low cost material. Thus, to eliminate PVC would leave hospitals no choice but to settle for an expensive alternative, driving up health care costs in general, which serves neither of the basic goods of health or life. DEHP gives uniquely versatile traits to PVC medical products, including superior strength, transparency, softness, flexibility, resistance to kinking, and the ability to double the life of red blood cells. The American Council on Science and Health noted in its 1999 Blue Ribbon Report that “DEHP in medical devices is not harmful to even highly exposed individuals.” In addition, PVC has been approved by the U.S. Food and Drug Administration.

The bottom line is that Health Care Without Harm is attempting to eliminate all potential risks associated with PVC, while ignoring its life- and cost-saving benefits. Precautions are, of course, important. The basic Christian virtue of prudence indicates that this is reasonable. But the so-called “precautionary principle” has become a mainstay argument used by many environmental organizations to unreasonable ends. Under the precautionary principle, technologies and products have to be banned if they are found to pose even the slightest risk.

HCWH has managed to apply the precautionary principle to health care, as well, where an obsession to eliminate all risk–an impossible task in this area–carries consequences that often jeopardize the quality of health care that we all depend on. Ironically, while decades of study on PVC have not produced conclusive risk findings, HCWH has not suggested that the same rigor of analysis be used toward its suggested alternatives. Held to the same standards as PVC, the precautionary principle would require all alternatives to “cause no harm,” a test that few, if any, products can pass. An excessively precautionary approach forces innovative, life-saving techniques and material to be needlessly overlooked.

HCWH also points to concerns about the dioxin emissions from PVC incineration. Certainly, some studies have shown dioxins to be a toxic pollutant. However, dioxin emissions have been consistently falling, even though PVC use has been rising. The EPA reports that dioxin emissions decreased by 75 percent from 1987 through 1995. In the EPA's Final Federal Plan for Existing Hospital, Medical, Infectious Waste Incinerators, guidelines require hospitals to reduce their dioxin emissions by approximately 95 percent. Dioxin emissions have already reached relatively low levels and medical waste incineration will soon account for a negligible portion of total emissions. However, for some people, even these regulations are considered inadequate. A HCWH-member organization, the Natural Resources Defense Council, is currently suing the EPA for not restricting medical waste incineration even more.

Hospitals need not buy into such alarmist pressure. We all deserve a health care system that is consistently able to meet the challenge to provide patients with the best products on the market, while remaining true to the Judeo-Christian prohibition against intentionally acting in evil ways. While product safety may be challenged on valid grounds, health care providers would do best to not fall into the trap of believing every alarmist concern that comes their way.